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LEA Program Provider Requirements

LEA Provider Responsibilities Include:

Complying with California Welfare and Institutions Code (W&I Code), Chapter 7 (commencing with Section 14000); and in some cases, with Chapter 8 (commencing with Section 14200); California Code of Regulations (CCR), Title 22, Division 3 (commencing with Section 50000); and California Education Code, Articles 1, 2, 3, 4, 4.5 and 15 and Sections 8800 and 49400; all as periodically amended.

 

Billing only for LEA services rendered by qualified medical care practitioners within the practitioner’s defined scope of practice.  A list of the health professionals who are qualified rendering practitioners and the specific qualifications those practitioners must meet are included in the LEA Rendering Practitioner Qualifications (loc ed rend) section of the LEA Provider Manual.

 

Submitting a Provider Participation Agreement/Annual Report (PPA/AR) and Cost and Reimbursement Comparison Schedule (CRCS) to DHCS annually as required in the Provider Participation Agreement.

  • The PPA is a contract, which permits qualified LEAs to participate as providers of services under the State Medicaid program, Medi-Cal.  This contract sets out responsibilities relative to participation in the LEA Medi-Cal Billing Option Program.  The LEA Annual Report shall include data on expenditures and activities in the preceding fiscal year (July 1 – June 30), and funding availability and service priorities for the current fiscal year.  Continued enrollment is contingent upon an LEA Annual Report being submitted.

 

  • The CRCS calculates the difference between costs incurred by LEAs and interim reimbursement payments received during the fiscal year, which will result in an LEA overpayment or underpayment.  The LEA responsibility in the CRCS process is as follows:
  1. Report costs associated with the direct provision of health services
  2. Report hours worked by qualified practitioners (employees and contractors)
  3. Identify direct costs and hours associated with FTEs funded by federally-funded programs outside of the LEA Billing Option Program
  4. Report Medi-Cal interim reimbursement received and time spent (units and/or encounters) for providing service 
  5. Provide information in the unshaded portions of the CRCS worksheets 
  6. Sign the certification statement once the forms are completed
  7. Compile and maintaining documentation that supports the CRCS
Additional Information regarding the LEAs responsibilities can be found in the LEA A Providers Guide (loc ed a prov) section of the LEA Provider Manual.
Last modified on: 7/5/2016 1:29 PM